Disasters and helpers: Psychological dynamics and implications for counselling

This paper reviews the recent research on those individuals who might be regarded as the ‘hidden victims' of disasters—the ‘Helpers'. It focusses on the complex interaction between disaster events, coping strategies and individual and personality factors as determinants of psychological and emotional problems in helpers. The discussion seeks to heighten the awareness of professional counsellors of the contribution that they can make to the training, debriefing and counselling of individuals fulfilling the role of helper by illustrating the problems that typify the helper's experience and by discussing a technique for dealing with these problems. Being prepared for the type of problems likely to be encountered and how these problems might be tackled is an important determinant of the effectiveness of the service provided. Duckworth's (1986) problem-solving approach to counselling helpers is assessed and subsequently used as a basis for discussing the role of the above information in the design and application of this problem-solving approach to dealing with the difficulties experienced by helpers as a result of their involvement in disasters.     

Face-to-face and at a distance: The mediation of guidance and counselling through the new technologies

The hitherto widely-held assumption that the counselling interaction should be conducted face-to-face, while other activities within the overall guidance process could be supported by computer, is re-examined. Recent computer-mediated information and communications technologies are reviewed, and their implications for guidance and counselling as a whole are explored. While fears are still current that human relations will be mechanised through the use of the information and communications technologies, it is contended that human relations will be changed but not necessarily diminished. Comparisons are drawn with the ways in which open and distance learning have brought a re-examination of what is understood to be a 'real' teaching interaction. It is suggested that practitioners in the fields of guidance and counselling must similarly be prepared to manage radical change.     

Counselling in primary care: a systematic review of the research evidence

Counselling in primary care in the UK is expanding rapidly, and its evidence base needs to be established. We present the rationale for conducting controlled trials of counselling in primary care, and suggest that a systematic review of controlled trials of counselling in primary care is timely. We describe the process of conducting the review in accordance with Cochrane Collaboration guidelines. The review aimed to assess the effectiveness and cost-effectiveness of counselling in primary care, by systematically reviewing cost and outcome data from randomised controlled trials and controlled patient preference trials of counselling interventions, for patients with psychological and psychosocial problems considered suitable for counselling. The search strategy, inclusion and exclusion criteria, data collection and data analysis are described. The results of the review are presented. The review included only controlled trials of counselling in which counsellors accredited by the British Association for Counselling (or equivalent) provided non-directive counselling in primary care. Four trials met the inclusion criteria. Results indicated that patients who receive counselling show a modest but significant improvement in symptom levels compared with those who receive GP care. Levels of satisfaction with counselling are high. There is very tentative evidence to suggest that counselled patients are more likely to be considered recovered than usual GP care patients. There is limited information about the cost-effectiveness of counselling. We conclude by reflecting upon the results of the review and their implications for counselling research.     

Grief counselling in context: Multiple roles and professional compromise

The issues involved in the use of counselling skills and approaches by members of professions such as nursing and social work have received relatively little research attention. Grief counselling represents an appropriate area in which to explore these issues, since members of many diverse professional groups may be called on to work therapeutically or supportively with the bereaved. This paper explores the use of grief counselling in a variety of professional and voluntary contexts, through an analysis of the experience of students who had undertaken a bereavement counselling course. The aim of the study was to explore the level of awareness shown by employing organisations to the 'loss' element of client experience, and the implications of organisational context for the role of counsellor as a worker responding to client grief. A range of practice characteristics emerged. At one end of the spectrum was clearly focused and contracted grief counselling, usually within the context of specialist voluntary agencies. By contrast, there were practitioners whose counselling response to grief was concealed within a multi-professional perspective characterised by compromise, usually working in complex organisational contexts in the statutory sector. It is argued that the range of practitioner activity cannot be understood simply by describing some activities as counselling and others as the use of counselling skills; it seems that there is a real and sometimes subtle middle ground which lies between the two. This is territory which is determined by the context of practice and needs to be understood and defined as such     

The impact of Christian counselling on survivors of sexual abuse

The absence of research and growing involvement of Christians in all areas of counselling gave rise to this study which explores the impact of Christian counselling on adult survivors of sexual abuse. The sample of 44 women and 5 men from an inter-denominational, self-help network, completed a self-report questionnaire of perceived Christian and professional counselling experiences involving issues of trust, power, directive approach, use of prayer and Scripture, responsibility and outcome. Results show that Christian counselling is experienced as qualitatively different from professional counselling: Christian counsellors are perceived as significantly more directive and more powerful than professional counsellors and the overall outcome was perceived more negatively. A number of key factors were identified which influenced the negative experience of some Christian counselling. These included having experience of professional counselling, an emphasis on the use of prayer and Scripture, perceiving the counsellor to have different goals from the client, feeling blamed for continued distress and having prior experience of prayer ministry. Implications for counselling practice and training are discussed.     

Ethical issues in internet counselling

This paper examines the advantages and difficulties associated with using the internet as a communication medium for counselling. Access to the internet is increasing rapidly and counselling services are starting to be offered to clients. Such services may be particularly attractive to clients who may not be able to find such services locally. The disadvantages of using the internet for counselling include the loss of the non-verbal communication level. The paper addresses the ethical implications of counselling in this medium. It concludes that there is a need for more guidelines in professional codes of practice.     

Barriers and challenges in the practice of multicultural counselling in Malaysia: A qualitative interview study

Counsellors face a lot of problems and stressors in their daily lives. As a person, counsellors may face challenges to deal with their personal expectations and responsibilities in life, work, family and community. As a professional, counsellors may face difficulties in dealing with professional issues and ethical dilemmas in their professional practice such as countertransference and value conflicts. These raise issues concerning their perceived multicultural competence and the adequacy of their training. Informed by a multicultural counselling perspective and drawing on semi-structured interviews with 12 professional counsellors in Malaysia, this study discusses the types of barriers and challenges faced by Malaysian counsellors and how these challenges were manifested and addressed in the cross-cultural counselling sessions. Results revealed five emerging themes based on participant counsellors’ responses on the barriers and challenges encountered in their practice of multicultural counselling in Malaysia. These were challenges related to counsellors’, clients’, presenting issues’, third-party and specific contexts’ characteristics. Research implications for the education and training of counsellors in the specific Malaysian socio-political context are also discussed.     

Training and Research in Counselling

Formal counselling training in Britain began with the preparation of school counsellors in universities and relied largely upon American models. Early courses were highly didactic but over the last decade practical and experiential aspects have taken precedence. Basic counselling training has now been extended into the preparation of many workers, voluntary and professional. Counselling research also had academic origins, but has broadened to include many different work settings. Much of the published research has been in the form of surveys of counselling services, but some detailed studies of process are noted. There is a need for research to be increased, and the gap between research and practice shortened, if counselling is to demonstrate its relevance to contemporary needs.     

Private work in public places: Confidentiality and role tensions in a university counselling service

This paper aims to explore issues of confidentiality relating to working with undergraduate and postgraduate students in a university counselling service. The context of a counselling service within our institute of higher education has to be understood in its relationship to academic, administrative and managerial staff, to medical and psychiatric services personnel and to the wide range of other student support and welfare services in the organization whether run by university staff or the students' union. Some reflection will be given to the need for clarity in the range of roles counsellors have to play within the different functions of the university. The client-counselling relationship cannot be seen as a dyad but as a triad or an even more complex constellation of relationships when regarded in an institutional context. The central premise is based on understanding the conscious and unconscious dynamics in the institution and how these impinge on the relationship between client and counsellor in challenging or assuming the confidentiality held by the service. Such boundary issues are identified in consultation and referral, breaking confidentiality, referral of disruptive students, calls for help and holding confidentiality. The case material drawn on to illustrate these five areas is also described in terms of anxieties raised and how these are projected, introjected and contained.

Within the service client and counsellor contract to work together. It is made clear that counselling is a professional relationship with agreed boundaries and a commitment to confidentiality. This is crucial to the working relationship and is a means of providing the client with both safety and privacy. Any limitation on the degree of confidentiality offered may reduce the usefulness of counselling. Bound by his or her professional code of ethics the counsellor will reach an agreement with the client at the outset about the extent of confidentiality they are offering, take care not to disclose information given in confidence and, when possible, be able to negotiate any change in agreement with the client.

Exceptional circumstances which may occur and give rise to the counsellor's decision to break the confidentiality formerly agreed between him or herself and the client are those which give grounds for believing the client will cause serious harm to others or themselves or have harm caused to them. Reference will be made to the role of consultant supervision in such situations and how any breaking of confidentiality can best be minimized. Attention will be given to the relevant ethical codes to which counsellors adhere and the issues of confidentiality within the legal process as well as whether the requirements of providing counselling services for students in higher education impel us, logically and practically, towards certain policies in regard to boundaries.     

A Controlled Explosion? a Decade of Counselling Training

The dramatic increase in size of counselling courses in Leicester is illustrated. Opportunities and problems created both by their location within an adult education programme and also by large numbers are outlined. The incentive for innovative development as a result of working with such large numbers is suggested. Questions are raised about the relationship between quality and quantity, especially for the depth of personal and professional learning.     

The student counsellor as a team member

Describing the future roles and services of British counsellors in higher and further education must not be done in professional isolation. We need to consider how the future roles of professional counsellors will positively affect the counselling done by academic staff Furthermore, rather than making generalisations about counselling needs, it may be better for working parties or task forces to develop counselling models which are appropriate to particular institutions. Such task forces should address some of the pressing issues confronting academic institutions: for example, (1) the revitalisation of the curriculum; (2) the improvement of the out-of-classroom relationships between academic staff and students; and (3) the development and maintenance of effective systems of academic government. If counsellors are to develop services which will help to resolve some of the problems associated with these issues, they will have to be increasingly clear about their own values.     

Obtaining informed consent for HIV antibody testing: the decision making process

All patients referring themselves for HIV antibody testing must receive pre-test counselling and must give their informed consent before testing can proceed. All patients being referred by their doctors for HIV antibody testing must also receive pre-test counselling and must give their informed consent before testing can proceed, except in very unusual circumstances. This paper is written primarily for medical and nursing staff who are considering referring a patient for testing and it is particularly relevant to those staff working in the field of mental health. This paper draws on professional guidelines and suggests that staff use a two-part decision making process. In the first part die referrer decides whether there are substantial clinical grounds for needing the test result immediately. If there are, the referral is made for pre-test counselling and testing, for example at the local Genito-Urinary Medicine (GU) clinic. In the second part experienced AIDS counsellors try to enable the patient to decide whether or not to proceed. If the patient is not able to understand or make a decision the AIDS counsellors, in consultation with other staff, will decide whether to proceed. Whatever the decision, it should be respected by professional staff.     

The professional identity of counselling psychologists in health care: a review and call for research

Despite (a) anecdotal evidence which suggests that it is possible to be a counselling psychologist in non-traditional settings, and (b) the potential integration of counselling psychology foci with the medical model, there has been some discussion about whether counselling psychologists who practice in health care settings might experience a change in their professional identity. Professional identity is defined here as a sense of connection to the values and emphases of counselling psychology. The retention of professional identity seems important for counselling psychologists in health care settings. This is considering that the application of counselling psychology principles has the potential to make their contributions unique among mental health professionals in the health care arena. Here, the authors describe the evolution of ‘counselling health psychology’ and address issues of professional identity. Limitations of existing literature are examined. Recommendations for future research are also made.     

Cancer counselling in the United Kingdom

Abstract

A national survey of 289 people from a variety of professions (nurses, social workers, clinical psychologists, psychiatrists, etc) involved in counselling cancer patients and their families within the United Kingdom obtained a response rate of 82%. The primary findings discussed in this paper cover a range of issues, including the working conditions and responsibilities of the counsellors, what professional qualifications they possess, the extent and availability of supervision and support, as well as the types of counselling intervention employed. Particularly disturbing was the fact that only 25% of our sample had any recognised formal counselling qualification and that 75% did not belong to any professional counselling organisation. In view of the wide diversity of qualifications, salary scales, responsibilities and working conditions and practices amongst the respondents, we propose that the National Health Service (NHS) should establish clearer guidelines as to the minimum acceptable qualifications for people employed as oncology counsellors, and that more adequate provision and resources are made available for training and supervision.     

Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology

A significant proportion of the counselling that people receive takes place within informal, situated encounters between service users and practitioners in fields such as nursing, medicine, teaching and social work. However, almost all of the research that has been carried out into the process and outcomes of counselling consists of studies of formal, contracted counselling and psychotherapy based in therapy clinics and offices. The competent and effective delivery of counselling that is embedded in a primary professional role, such as that of nurse, teacher or social worker, presents considerable challenges for practitioners. Research evidence around the process and outcomes of embedded counselling represents a valuable resource that has the potential to enhance the quality of counselling conversations enacted by practitioners in health, education, social work and other professions. An overview is provided of different types of research that has been carried out into informal and embedded counselling, and of the main themes that have emerged from these studies. Suggestions are made for the further development of this field.     

Counselling effectiveness: A critical discussion

Studies of counselling effectiveness are examined critically with respect to the measures they use, their methodological weaknesses, and problems of interpretation. The deficiencies of various measuring devices — including unstructured accounts, structured questionnaires, pre- and post-counselling ratings, physiological indicators, experimental investigations, and social actions effects — are discussed. Many of the experiments are criticised for poor design and over-interpretation of findings. Fundamental methodological problems are also discussed, including the extent to which the effectiveness of counselling can appropriately be examined by existing scientific methods. More knowledge of counselling processes is required before there can be any satisfactory measurement of counselling effects.     

A model of short-term counselling in primary care

Counselling in prima y care settings has received much interest throughout Britain. Many surgeries employ counsellors or psychologists as part of the primay health care team. This paper describes a model of primary care counselling using an example of a case encountered in general practice. It emphasizes the advantages of offering on-site counselling services, such as better possibilities of liaison with the referring doctor and coordination of patient care. Progress was made in seven sessions of short-term cognitive-behavioural treatment and a more stigmatizing referral (for example, to psychiatric services) was avoided. The case can be seen as an appropriate referral in the context of primay care counselling and illustrates the benefit of this approach to the treatment of psychological and social problems in general practice. Names and details have been changed to preserve confidentiality.     

Introducing humanistic group counselling for somatisation in a primary care practice: Preliminary findings

Can group counselling help patients who present with symptoms that cannot be explained medically? Preliminary results of working with one such group are reported. Six patients in a primary care practice were offered weekly sessions for half a year. The findings suggest that the patients attended all group sessions. The patients reported experiences known to be related to group counselling, and when the group ended, patient reports show that the severity of their problems was reduced significantly (p<.001). Furthermore, during the six months after the group ended patients significantly (p<.025) reduced their visits to their general practitioners. These results seem to call for wider use of humanistic group counselling with somatising patients and further research into the impact of such form of counselling.     

Results of a Citation Analysis of the Career Counselling Field from an African Perspective

The study examined research and trends in career counselling published in selected professional sources during the period 1980–2010. Citation analysis was used in this study to investigate documents which were indexed in the Web of Science related to career counselling. Career counselling and related keywords were used jointly in the search for documents. There were a total of 730 documents judged to be relevant to the field of career counselling and were citation analysed. The number of citations related to the career counselling field has been increasing continuously since 2000. Research publications on career counselling are projected to increase for both South African authors and the authors of other African countries.     

An Evaluation of Training in Basic Counselling Skills

A 60-hour course to train community-health professionals in the basic skills of counselling families of children with disabilities was evaluated. Three groups of diverse professionals (25 females and 1 male in all) were trained. The overall approach followed the didactic-experiential programme of Truax and Carkhuff (1967). Teaching methods included discussion, role-play, and feedback. Hypothesised changes occurred in trainees as a result of the course in contrast with a non-training waiting period. There were significant improvements in theoretical knowledge, self-perceptions of counselling ability and counselling behaviour. Evidence from a sub-group of the sample indicated that changes were maintained for up to nine months afterwards. The validity of the results is further supported by a separate study demonstrating benefits in families with whom the trainees subsequently worked. It is concluded that such courses are cost-effective in enhancing the professional skills of health-care workers.